Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

Chang, Yu-Chieh; Tseng, Shuo Yen; Tseng, Sung Huei; Wu, Chao‐Liang

doi:10.1097/01.ico.0000220775.93852.02

Cited by 45 publications

(47 citation statements)

References 32 publications

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“…The characteristic lesion begins in the periphery of the cornea and spreads circumferentially (6). The leading edges of the ulcer are undermined, infiltrated and de-epithelialized.…”

Section: Discussionmentioning

confidence: 99%

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Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

Shi

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The present report describes the clinical course and treatment of a Mooren-like ulcer associated with abuse of topical anesthetics and dexamethasone. A 38-year-old male physician treated himself with lidocaine, tetracaine and dexamethasone (DEX) eye drops for severe pain and decline of vision in both eyes. After six months of treatment, his right cornea exhibited annular melting with full-thickness stromal infiltration at the limbus and central corneal haze. His left cornea was completely melted and exhibited iris prolapse. The patient was treated with topical antibiotics, lubricants and underwent a binocular keratoplasty. The surgery was successful and after eight months the postoperative best-corrected visual acuities were counting fingers in the right eye and light perception in the left eye. In summary, this report documents a severe case of keratopathy presenting as Mooren-like ulcer caused by topical anesthetics and DEX, which were treated via keratoplasty, resulting in useful vision being retained.

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“…The characteristic lesion begins in the periphery of the cornea and spreads circumferentially (6). The leading edges of the ulcer are undermined, infiltrated and de-epithelialized.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism underlying toxic keratopathy may include damage of the corneal epithelial barrier and disruption of re-epithelialization (6). A healthy epithelial surface protects the cornea from potential infection and the invasion of various microbial pathogens.…”

Section: Discussionmentioning

confidence: 99%

Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

Shi

et al. 2016

Experimental and Therapeutic Medicine

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“…Although topical anaesthesia is very popular in some countries, caution is required. Chang et al, 11 for example, have demonstrated in a rabbit model that local anaesthetic drops can cause dose and time-dependent cytotoxicity, usually within the first minute of contact with corneal endothelium. Guzey et al 12 have demonstrated the risks of corneal endothelium damage following the application of topical anaesthesia in patients.…”

Section: Sub-tenon's Blockmentioning

confidence: 99%

Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

Zundert

Kumar

2008

Southern African Journal of Anaesthesia and Analgesia

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Loco-regional anaesthesia is commonly used for both intraocular and extraocular surgical procedures, although the provision and use of the anaesthetic technique varies worldwide. Injection techniques (retrobulbar, peribulbar and sub-Tenon's blocks) are associated with significant pain; indeed, many patients have a fear of pain. Discomfort during injection can, however, be reduced and patients can be made comfortable through reassurance, careful performance of the technique and the provision of sedation and/or analgesia. In this article, the authors describe common loco-regional anaesthetic techniques and measures to reduce discomfort during injection, thus improving patient satisfaction.

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“…It can result in corneal thickening, opacification and significant corneal endothelial cell loss when applied intracamerally [12]. In addition, administration of lidocaine has been shown to cause an increase in apoptotic cells in corneal endothelium in rabbit models [13]. However, the side effects of lidocaine on HCE cells and their mechanism remain unknown.…”

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confidence: 99%

Cytotoxicity of Lidocaine to Human Corneal Endothelial Cells In Vitro

Wang

et al. 2014

Basic Clin Pharma Tox

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Lidocaine has been reported to induce apoptosis on rabbit corneal endothelial cells. However, the apoptotic effect and exact mechanism involved in cytotoxicity of lidocaine are not well-established in human corneal endothelial (HCE) cells. In this study, we investigated the apoptosis-inducing effect of lidocaine on HCE cells in vitro. After HCE cells were treated with lidocaine at concentrations of 0.15625-10.0 g/l, the morphology and ultrastructure of the cells were observed by inverted light microscope and transmission electron microscope (TEM). Cell viability was measured by MTT assay, and the apoptotic ratio was evaluated with flow cytometry and fluorescent microscopic counting after FITC-Annexin V/PI and AO/EB staining. DNA fragmentation was detected by electrophoresis, and the activation of caspases was evaluated by ELISA. In addition, changes in mitochondrial membrane potential were determined by JC-1 staining. Results suggest that lidocaine above 1.25 g/l reduced cellular viability and triggered apoptosis in HCE cells in a time-and dose-dependent manner. Diminishment of DΨm and the activation of caspases indicate that lidocaine-induced apoptosis was caspase dependent and may be related to mitochondrial pathway.Human corneal endothelium (HCE), a functional monolayer forming the demarcation between cornea and anterior chamber, plays pivotal roles in maintaining corneal transparency by regulating corneal stromal water content [1]. Notwithstanding the evidence of proliferation when deprived of their nature environment, HCE cells are trapped in the G1 phase of the cell cycle and have a limited, if not restricted, proliferative capacity in vivo [2,3], accompanied by an annual attrition rate of 0.3-0.6% in cell density during adulthood [4].In addition to ageing, excessive HCE cell loss may result from accidental injuries, surgical trauma and diseases [5][6][7] which consequently impair the physiology of cornea. Due to the inability of HCE to be repaired through cell number increase, wound healing can only be achieved by enlargement and migration of the neighbouring cells. However, if the decline of cell density transcends a threshold, the integrity of the corneal endothelium will be compromised, resulting in painful corneal oedema and ultimately loss of visual acuity. Recently, increased evidence has revealed corneal endothelium damage to be associated with abused administration of topical anaesthetics [8][9][10].Lidocaine is one of the most frequently used topical anaesthetic agents in ophthalmic surgeries for its inherent potency, rapid onset, tissue penetration and efficiency [11]. It can result in corneal thickening, opacification and significant corneal endothelial cell loss when applied intracamerally [12]. In addition, administration of lidocaine has been shown to cause an increase in apoptotic cells in corneal endothelium in rabbit models [13]. However, the side effects of lidocaine on HCE cells and their mechanism remain unknown. In this study, we aimed to investigate the apoptosis-inducing e...

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Cytotoxicity of Lidocaine or Bupivacaine on Corneal Endothelial Cells in a Rabbit Model

Cited by 45 publications

References 32 publications

Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

Cytotoxicity of Lidocaine to Human Corneal Endothelial Cells In Vitro

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